From Apprenticeship to Artificial Intelligence: 250 Years of Dentistry

By Genni Burkhart, Editor

In 1776, dentists in the United States primarily learned their profession through apprenticeship, decades before formal education and most of the scientific principles that define modern dentistry today.

As the United States marks its 250th anniversary next month, it's also worth looking at how dentistry has changed over the same 250 years. While formal dental education didn't exist in 1776, neither did many of the tools clinicians now use every day. Yet, the profession's foundational responsibilities—relieving pain, treating disease, restoring function, and improving quality of life—remain just as relevant in 2026.

Dentistry Finds Its Foundation

At the time of this nation's founding, dentistry was, understandably, very different from the profession we know today. As dentists learned through apprenticeship, standards varied widely, and treatment options remained highly limited. Extractions accounted for much of the work, primarily because there weren't many alternatives.

A major turning point arrived in 1840 with the opening of the Baltimore College of Dental Surgery, recognized as the world's first dental school. The institution also introduced the Doctor of Dental Surgery degree, a credential still used by many dentists today. Formal education created a more consistent way to share knowledge, establish standards, and build a solid scientific foundation for the profession.

The American Dental Association (ADA) was formed in 1859 and helped advance education, ethics, and professional standards nationwide. Those developments helped move dentistry beyond local apprenticeship models and toward a profession supported by organized education, research, and scientific exchange.

While better education strengthened the profession, it did little to address one reality every dentist understood. Dental treatment could be painful, and people often delayed care until problems became impossible to ignore.

The Pursuit of Pain Control

In 1844, Connecticut dentist Horace Wells attended a public demonstration involving nitrous oxide and immediately recognized its potential for pain control. Convinced he had discovered something important, Wells later attempted a public demonstration in Boston. Unfortunately, observers at that time viewed his demonstration as a failure. However, his efforts weren't in vain, as Wells is now widely recognized as one of the pioneers of anesthesia. He also helped lay the groundwork for one of the most important advances in dental history: pain management.

This discovery helped clarify a fundamental factor in modern dentistry—pain control expanded what dentists could realistically accomplish and often reduced the fear that kept patients from seeking treatment. As anesthesia advanced, clinicians gained greater opportunities to preserve teeth, perform more complex procedures, and intervene before disease became severe. Even then, another limitation remained. Dentists could do more than ever before, but they still had limited ways to evaluate what was happening beneath the surface.

Gaining Valuable Insight

That changed in 1895 when Wilhelm Conrad Röntgen discovered X-rays.

Dentistry recognized the significance almost immediately, and within months, practitioners were widely experimenting with radiographic imaging. This advancement allowed them to address a challenge every clinician understood, which was a true lack of insight. For the first time, dentists could truly evaluate impacted teeth, bone loss, periapical pathology, and decay that visual examination alone couldn't. The ability to identify disease earlier influenced more than just diagnosis. It also encouraged a change in how clinicians approached oral health. If the disease could be detected sooner, perhaps it could be prevented more effectively as well.

Prevention Changes Expectations

For much of its history, dentistry focused on treating disease after it occurred. Improved diagnostics, expanding scientific research, and growing public health efforts gradually shifted attention toward prevention.

One of the most influential developments occurred in 1945 when Grand Rapids, Michigan, became the first city in the world to fluoridate its public water supply. Over the following decades, fluoride became one of the most widely studied public health measures in dentistry. Preventive dentistry, oral hygiene education, sealants, and risk-based approaches also encouraged earlier intervention and long-term disease management. As a result, dentistry began focusing on reducing disease before treatment became necessary. Meanwhile, advances in materials and restorative techniques continued to expand what clinicians could offer when treatment was required.

New Materials, New Possibilities

George Washington's dentures remain one of the most persistent myths in American history. Although they're often remembered as wooden, surviving dentures incorporated human and animal teeth, ivory, gold, lead, and other materials. Historical records also document payments to enslaved individuals for teeth, reflecting both the limitations of eighteenth-century dentistry and the realities of the era.

Tooth replacement remained difficult and expensive for much of the nineteenth century. The introduction of vulcanized rubber denture bases helped change that by making dentures more affordable than earlier gold-based alternatives. The pace of innovation only accelerated during the twentieth century. In 1957, John Borden introduced the Airotor, the first successful air-driven high-speed dental handpiece. Dentists could now complete procedures that once required significantly more time, far more efficiently, helping reshape restorative dentistry.

New restorative materials followed, implant dentistry expanded treatment options for missing teeth, and adhesive techniques improved conservation of natural tooth structures. Diagnostic technology continued advancing as well. Digital radiography streamlined imaging workflows, while dental cone beam computed tomography systems became available in the United States during the early 2000s. Three-dimensional imaging gave dentists a level of visualization that previous generations simply never had. While many of these developments now feel routine, they arrived within the professional lifetimes of dentists still in practice today.

Artificial Intelligence and the Next Chapter

Artificial intelligence (AI) is already appearing in areas such as imaging analysis, workflow management, documentation, and clinical decision support.

Unlike many earlier innovations, AI isn't just tied to a single device or procedure. AI is also one of the most controversial topics in modern life, and while some applications may prove valuable, others may not. As we reflect on dentistry's evolution, it's important to remember the profession has a long history of evaluating new technologies, adopting those that improve patient care, and leaving others behind.

From Horace Wells to Modern Sedation

Today, dentists have access to oral sedation, IV sedation, modern anesthetic agents, advanced monitoring equipment, and evidence-based protocols that would have been unimaginable in the eighteenth century. Yet it's hard to conceive of those advancements without the pioneering efforts of people like Horace Wells, W.C. Röntgen, John Borden, and many others who were willing to expand their knowledge and even risk their reputations to advance oral health. After 250 years of progress, fundamentally, your patients still arrive seeking relief from pain, treatment for disease, restoration of function, and trust in your skills as a dentist. While much has changed in dentistry over the centuries, the basic principle of putting the patient first has not.

Author: With over 16 years as a published journalist, editor, and writer, Genni Burkhart's career has spanned politics, healthcare, law, business finance, technology, and news. She resides in Northern Colorado, where she works as the editor-in-chief of the Incisor at DOCS Education.

References:

1. American Dental Association. Artificial intelligence in dentistry. American Dental Association. n.d. https://www.ada.org/resources/practice/dental-standards/artificial-intelligence-in-dentistry
2. American Dental Association. History of the ADA. American Dental Association. n.d. https://www.ada.org/about/history-of-the-ada
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4. Mount Vernon. George Washington's teeth. n.d. https://www.mountvernon.org/george-washington/health/washingtons-teeth
5. National Institute of Dental and Craniofacial Research. The story of fluoridation. National Institutes of Health. n.d. https://www.nidcr.nih.gov/health-info/fluoride/the-story-of-fluoridation
6. Smithsonian Institution, National Museum of American History. Tooth key. n.d. https://americanhistory.si.edu/collections/object/nmah_1098823
7. University of Maryland School of Dentistry. History of the University of Maryland School of Dentistry. n.d. https://www.dental.umaryland.edu/about/history/
8. University of the Pacific, Arthur A. Dugoni School of Dentistry. A dynamic decade: Speeding up the handpiece. n.d. https://dentalmuseum.pacific.edu/a-dynamic-decade-speeding-up-the-handpiece/